Stimulant Use Disorder
DSM-5 Diagnostic Criteria A'''. A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: # The stimulant is often taken in larger amounts or over a longer period than was intended. # There is a persistent desire or unsuccessful efforts to cut down or control stimulant use. # A great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects. # Craving, or a strong desire or urge to use the stimulant. # Recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home. # Continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant. # Important social, occupational, or recreational activities are given up or reduced because of stimulant use. # Recurrent stimulant use in situations in which it is physically hazardous. # Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant. # Tolerance, as defined by either of the following: #* '''a. A need for markedly increased amounts of the stimulant to achieve intoxication or desired effect. #* b'''. A markedly diminished effect with continued use of the same amount of the stimulant. #* '''Note: This criterion is not considered to be met for those taking stimulant medications solely under appropriate medical supervision, such as medications for attention-deficit/hyperactivity disorder or narcolepsy. # Withdrawal, as manifested by either of the following: #* a'''. The characteristic withdrawal syndrome for the stimulant. #* '''b. The stimulant (or a closely related substance) is taken to relieve or avoid withdrawal symptoms. #* Note: This criterion is not considered to be met for those taking stimulant medications solely under appropriate medical supervision, such as medications for attention-deficit/hyperactivity disorder or narcolepsy. Specify if: * In early remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the stimulant," may be met). * In sustained remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the stimulant," may be met). Specify if: * In a controlled environment: This additional specifier is used if the individual is in an environment where access to stimulants is restricted. Note: If an amphetamine intoxication, amphetamine withdrawal, or another amphetamine-induced mental disorder is also present, the comorbid amphetamine use disorder is indicated in the amphetamine-induced disorder. For example, if there is comorbid amphetamine-type or other stimulant-induced depressive disorder and amphetamine-type or other stimulant use disorder, only the amphetamine-type or other stimulant-induced depressive disorder diagnosis is given, with the recording indicating whether the comorbid amphetamine-type or other stimulant use disorder is mild, moderate, or severe (e.g., mild amphetamine-type or other stimulant use disorder with amphetamine-type or other stimulant-induced depressive disorder; moderate or severe amphetamine-type or other stimulant use disorder with amphetamine-type or other stimulant-induced depressive disorder). Similarly, if there is comorbid cocaine-induced depressive disorder and cocaine use disorder, only the cocaine-induced depressive disorder is recorded, with the diagnosis indicating whether the comorbid cocaine use disorder is mild, moderate, or severe (e.g., mild cocaine use disorder with cocaine-induced depressive disorder; moderate or severe cocaine use disorder with cocaine-induced depressive disorder). Specify current severity: * Mild: Presence of 2-3 symptoms. * Moderate: Presence of 4-5 symptoms. * Severe: Presence of 6 or more symptoms. Specifiers "In a controlled environment" applies as a further specifier of remission if the individual is both in remission and in a controlled environment (i.e., in early remission in a controlled environment or in sustained remission in a controlled environment). Examples of these environments are closely supervised and substance-free jails, therapeutic communities, and locked hospital units. Differential Diagnosis Primary mental disorders Stimulant-induced disorders may resemble primary mental disorders (e.g., major depressive disorder). The mental disturbance resulting from the effects of stimulants should be distinguished from the symptoms of schizophrenia; depressive and bipolar disorders; generalized anxiety disorder; and panic disorder. Phencyclidine intoxication Intoxication with phencyclidine ("PCP" or "angel dust") or synthetic "designer drugs" such as mephedrone (known by different names, including "bath salts") may cause a similar clinical picture and can only be distinguished from stimulant intoxication by the presence of cocaine or amphetamine-type substance metabolites in a urine or plasma sample. Stimulant intoxication and withdrawal Stimulant intoxication with withdrawal are distinguished from the other stimulant-induced disorders (e.g., anxiety disorder, with onset during intoxication) because the symptoms in the latter disorders predominate the clinical presentation and are severe enough to warrant independent clinical attention.